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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157700063
Report Date: 01/16/2024
Date Signed: 01/16/2024 09:55:36 AM

Document Has Been Signed on 01/16/2024 09:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 39115 TRADE CENTER DR STE. 201
PALMDALE, CA 93551
FACILITY NAME:MELVIN FAMILY CHILD CAREFACILITY NUMBER:
157700063
ADMINISTRATOR:CHUNTE MELVINFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 754-4394
CITY:CALIFORNIA CITYSTATE: CAZIP CODE:
93505
CAPACITY: 14TOTAL ENROLLED CHILDREN: 14CENSUS: 6DATE:
01/16/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Chunte MelvinTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Carol Heath and Crystal Ali met with the Licensee Chunte Melvim for a case management incident inspection involving an Unusual Incident Report (UIR) received by telephone on 11/13//2023. LPA toured the facility and took a census of the children. Upon arrival, there were 6 children (2 children are 1 year old,3 children are 2 years old and 1 child is 6 years old with Licensee today.

Description of the incident: An incident occurred on 11/13/2023. Child #1’s Mom called to report to Licensee that the child had a bump and bruise on the forehead. C1 was trying to sit on a child's couch; C1 fell backward and hit their head on the TV cabinet. The licensee consoled the child but did not notice a bruise or swelling. The licensee stated she did not know C1 was injured, so no aid was rendered. The licensee stated she did not contact the parents regarding the incident. The licensee stated she did not know C1 was injured, so no aid was rendered. The licensee stated she did not contact the parents regarding the incident.

Based on the interview conducted, the incident does not appear to have been the result of any violation of the Title 22 regulation. Therefore, no deficiencies were cited.

An exit interview was conducted, and a copy of this report was read and provided to Chunte Melvim, Licensee.
SUPERVISORS NAME: Claretta Yates
LICENSING EVALUATOR NAME: Carol Heath
LICENSING EVALUATOR SIGNATURE: DATE: 01/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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